First of all: this article is not about acute crises – these are a matter in themselves. There are regulations for acute treatment, but even then you can’t avoid looking for a therapist.
From time to time I am asked how to find a therapist or what can help a child of mentally ill parents. But these are two questions that go in different directions. The latter is the more difficult one, as it were, because there is no direct answer and certainly not THE answer. That is why this will be dealt with in another article.
Inpatient versus outpatient
Different options can be used purely in terms of the therapy framework:
- Inpatient psychotherapy in a hospital
- Outpatient psychotherapy in a counseling facility
- Outpatient psychotherapy with psychotherapists in private practice
I would like to focus here on outpatient psychotherapy with psychotherapists in private practice.
The following is also less about the purely technical aspects (invoices, formalities, contributions, etc.) and more about the question of what decisions I have to make as a patient.
Trusting the process
Since the formalities are often associated with frustration, if only because most practices (some say all) are full and it can sometimes take months for individual therapists to get a place, there is no point in getting upset about it. This may sound terse and dismissive, but is there a better option?
Although the care system has already adapted to this and made access easier, this does not mean that the therapist has enough time for regular therapy after the first so-called consultation appointments. Consultations are therefore the first appointments – in fact THE first appointment – where you are given a kind of initial diagnosis and an assessment is made as to whether and in what form therapy would be useful.
But if there are no appointments at first: It’s worth remaining confident. After all, therapists can also make referrals or recommendations. So ask the first therapist, if he or she has no capacity, whether he or she can recommend someone.
So trust that there will be a therapist who will accept you!
So how do I find the right therapist?
The telephone directory, the internet, friends and acquaintances or even family doctors can be the first places to look for telephone numbers. In all larger cities, there are often also advice centers that can provide further information. Unfortunately, the structure is not uniform throughout Germany, which is why a regional or local search is essential.
Of course, it helps if you already know a little more about your own topic or even have specific terms ready. More on this in a moment!
Motivation: Yes, I want to.
Abdominal surgery will probably work even if the patient doesn’t really want it and is afraid. However, once the patient is sedated, the surgeon can carry out his or her professional work.
Again, reluctance can be very counterproductive when it comes to psychotherapeutic “measures”. That may sound as if you first have to convert internally in order to achieve anything meaningful at all. And how is that any different from a placebo effect, you might object.
This aspect of the basic attitude alone would justify its own blog post, but I would just like to briefly hint here that you will necessarily be on the phone a lot at first when looking for therapy (why? See below!) But if you don’t really feel like therapy at all, you won’t pick up the phone again so quickly – and then it’s over anyway.
Furthermore, in my observation, psychotherapeutic treatment has a much better chance of success if you “join in”. This was particularly evident in the clinics I attended. Many patients who got involved in the whole thing simply made more “leaps” during this time.
This brings me to another important aspect: in my opinion, psychotherapy is ultimately and actually help for self-help. The therapist doesn’t play with you, he doesn’t give you anything and the therapy is not given to you. On the contrary: you have to (want to) participate! You have to want to cooperate! You have to help yourself!
This is of course particularly bad news for the children of mentally ill people, who have always had to take everything into their own hands anyway! And now again?
Yes, now again. Unfortunately.
The only difference is that all patients are equal here. No one can escape responsibility in the psychotherapeutic setting.
Why psychotherapy? Reason and goal
You are motivated to seek a therapist for some reason. The motive will usually not be too positive (“I won the lottery and now I have to make sure I don’t completely freak out!”).
Therefore: Know your reason why you want to undergo therapy in the first place!
These can be very different things – even several at the same time, but if in doubt, pick out the two or three most important moments and formulate them as clearly as possible when you talk to the first therapist about your treatment intentions.
For example (!) this could be as follows:
“I want to go to therapy because
- I can no longer fall asleep or sleep through the night.”
- I have palpitations.”
- I cry all the time and I don’t know why.”
- My wife/husband has left me.”
- I was on vacation with friends and we had a bad accident in which two of my friends died.”
- My father threw himself in front of a train, after which my mother became a paranoid schizophrenic and she also took her own life 20 years after her husband’s death. And I lived almost alone with her for ten years as a teenager.”
As you can see, the wording can be a description of symptoms or simply a description of circumstances. In any case, the more concrete the better, because then the therapist can best categorize it for themselves (why this is so important will follow).
Some also say: “…my family doctor thinks it might be useful to undergo psychotherapy.”
And if the therapist then asks: “Why does your GP think that…?”, then you will certainly have an answer to this question, because the GP will not have said this completely out of context.
“Concrete classification” therefore means “being specific” and not saying as much as possible. This may be difficult, especially at the beginning, because you often don’t have a clear idea of the context and may “only” be able to describe symptoms. But these are enough to want to change something.
Some people find it helpful to answer the question about the reason for the therapy in a different way by asking themselves: “What do I want to achieve with the therapy?” The guiding principle for this would then be analogous:
Know the goal you want to achieve with the therapy!
This goal does not have to be a professionally clear or medically known one, so it is not a matter of saying: “I want to minimize my suicidal tendencies.” Things like (again, examples) are enough:
“I would like to…
- not feel ashamed during sex.”
- can sleep at night.”
- get rid of my fears.”
- be able to feel myself again.”
- let out my anger against my grandfather.”
Ultimately, the two guiding principles mentioned here are closely related and it can’t hurt to have thought about both at some point.
It may seem surprising, but thinking about these questions is already therapeutic in nature.
In essence, not much more will happen at first than talking about your own reasons and background that led to therapy. However, the advantage of doing this with a therapist and not with your best friend is that therapists are trained not to lose sight of the important aspects.
Or to put it another way: therapy is all about you! Only about you!
The gut feeling, part 1
Not every therapist is suitable for every patient. This sentence is true because, as human beings, we are not able to get on with everyone, because we are not generally sympathetic to everyone and not everyone is sympathetic to us. At the same time, the therapist also has an effect of up to 15% on the success of the therapy.
A decision must therefore be made even if a therapist would be able to offer their services to you, at least in terms of time.
So you have to honestly answer the question: Do I want to work with this therapist?
However, this presupposes that you are in a position to assess for yourself whether the other person is suitable. For this purpose, there are so-called trial sessions, for which no application has to be made to the insurance company (yes, yes, I’ll leave out the formalities!) The purpose of the trial sessions is for both sides to get to know each other well enough to be able to decide whether and how to proceed.
The “how” mainly means how often sessions can be, but possibly also which techniques are advised. But that would be too many individual details for the moment.
However, it also means that it is not just you, but also the therapist who decides whether they want to work with you at all.Equal rights for all!
However, instead of being “everybodies darling”, it is more important to be as authentic as possible with your own issues and with yourself. Either way, it wouldn’t be very helpful (more of a hindrance) if you tried to play a role all the time. But most people who start therapy don’t do that anyway, otherwise they wouldn’t have started in the first place.
We are not Robert DeNiro and Billie Crystal.
What kind of psychotherapy should I do exactly?
Why this question is not asked right at the beginning of the process is because this is intended to be a guide for beginners. In most cases, the diagnosis and the question of the “type” of therapy are not yet clear. How are you supposed to find the right therapy if you don’t even know your own diagnosis yet?
Psychological and Medical Psychotherapies
Furthermore, we are talking about mental illnesses in a non-psychotic sense. If we are talking about psychoses, then the world and the associated issues look completely different, as psychiatric treatment (i.e. medication) may be necessary immediately.
The latter can also be the result of a psychotherapeutic consultation, but then it is not right at the beginning, also because not every psychotherapist is a medical psychotherapist.
If this is too much for you at this point, please skip to the last section of this article, which again deals with the question of gut feeling.
From the beginning: There are psychological and medical psychotherapists. Both have the same formal qualification as far as psychotherapy is concerned, but come from different backgrounds in order to obtain it:
- Psychologists first study psychology and THEN train as psychotherapists.
- Doctors first study medicine and THEN train as psychotherapists.
There is something to be said for both – but it is ultimately up to the patient to decide. I would use this as a rule of thumb: If your complaints are also very physical, then perhaps a doctor is recommended.
At the same time, it can be useful to take a completely different perspective from a non-medical point of view.
However, I would like to warn against the attitude: “Great! Then I’ll go to a doctor! He can prescribe me a pill and then everything will be fine again!” This contradicts the principle of helping people to help themselves. Of course, psychotropic drugs may be indicated and of course they also “work”. But on the one hand, we have a lively debate about the usefulness of these drugs, not least because individually adapted drugs would actually have to be developed (which would never pay off financially and the link also only shows an example contribution) and on the other hand, the view has prevailed that supplementing both approaches often has the greatest effect – provided that this complementary approach is also indicated (also only one contribution in the link).
In short, it remains to be seen whether and to what extent medication should be used at all (unless there is talk of psychosis). This cannot be said immediately or conclusively.
Three Categories of Health Insurance Companies (in Germany)
The question then arises as to the psychotherapeutic “orientation” of the therapist. However, a note in advance: the range of therapeutic methods is so diverse that there is no one ultimate method.
On Wikipedia alone, there are sixteen main groups with around 180 psychotherapy methods (including relaxation and group methods). And as far as their subject areas are concerned, these are sometimes at odds with each other. This means, for example, that approaches to trauma therapy can be found in different method boxes.
It is also helpful to at least somewhat understand the care system behind psychotherapies, i.e. what role the health insurance companies play in this, because the first thing you are confronted with is the corresponding categories of the health insurance companies.
You could say that the health insurance companies have divided the therapy landscape into three categories:
- Behavioral therapy
- Depth psychology
- Analytical
The world of health insurance companies is primarily concerned with financial issues and therefore with billing issues. In other words, the three categories mentioned here primarily serve this very purpose of structuring the landscape of therapy services, and this could not have been more crude. But ultimately, as we shall see, that doesn’t matter!
The three categories – as a rough statement – have little or nothing to do with the actual methods used, as they are far too general to be able to make a concrete statement about what exactly is being used.
This means that a therapist may be licensed as a behavioral therapist, but – especially if he is a good therapist – he will not only “poach” methodically in other “areas”, but will also deliberately use them to help you. Even if they are not recognized by the insurance company – because how are they supposed to check what exactly is going on between you and your therapist during the session?
But in my opinion this is more positive than negative, because on the one hand the therapists licensed by the health insurance companies are tested, which is supposed to prove their basic qualification, and on the other hand an alert therapist is quicker than the politicians when it comes to getting the best for the patient.
The Gut Feeling, Part 2
What has been said now means one thing above all for you:
Start making up your own mind!
And from this follows the next guiding principle:
If you like the therapist, start the therapy!
You will learn and recognize when a change will be necessary and what other paths there are. And: every therapy will have something in store for you!
I don’t mean that in a flowery or glorifying way at all, because in my opinion the complexity of a person and their psyche cannot be captured by just one perspective. It’s better to start by confronting your issues and seeing how far you get with your first chosen approach (or professional). And then look further.
This in turn implies a truth that must not be concealed: the whole thing takes time.
Unfortunately.
